An Aprotinin Containing Fibrin Sealant Does Not Reduce Blood Loss in Total Hip Arthroplasty

• Published in: The Journal of arthroplasty Vol. 32; no. 11; pp. 3445 - 3448
• Main Authors: Kearns, Sean M., MD, Kuhar, Hannah N., BA, Bohl, Daniel D., MD, MPH, Levine, Brett R., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2017
• Subjects: Administration, Intravenous; Antifibrinolytic Agents - therapeutic use; Aprotinin - therapeutic use; Arthroplasty, Replacement, Hip - adverse effects; blood loss; Blood Loss, Surgical - prevention & control; Blood Transfusion; Female; fibrin sealant; Fibrin Tissue Adhesive - therapeutic use; Hemoglobins - analysis; Hemostatics - therapeutic use; Hospitalization; Humans; Male; Middle Aged; Orthopedics; Outcome Assessment (Health Care); Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - prevention & control; Postoperative Period; Retrospective Studies; total hip arthroplasty; tranexamic acid; Tranexamic Acid - therapeutic use; transfusion; total hip arthroplasty; transfusion; fibrin sealant; blood loss; tranexamic acid
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.05.040

Abstract Background Fibrin sealants are topical agents used to reduce perioperative blood loss; however, their efficacy in total hip arthroplasty (THA) remains uncertain. The purpose of this study was to determine if a fibrin sealant containing aprotinin as an antifibrinolytic agent, TISSEEL (Baxter, Deerfield, IL), reduces postoperative blood loss and transfusion during THA when compared with intravenous (IV) tranexamic acid (TXA) and control groups. Methods Three retrospective uniform cohorts of primary THA procedures were identified, from a prospectively maintained database: 1 group who received TISSEEL, 1 group who received 1 g IV TXA, and 1 group who received neither (control). There were 80 patients in each group. Outcome measures included the lowest measured hemoglobin during postoperative hospitalization, greatest decrease in hemoglobin from preoperative to postoperative values, and blood transfusion rates. Results The minimum postoperative hemoglobin level was significantly lower for TISSEEL patients compared with that of IV TXA patients ( P  = .021) and no different when compared with that of control patients ( P  = .134). Patients receiving fibrin sealant had a greater hemoglobin level decrease compared with that of IV TXA ( P  = .029) and control ( P  = .036). Postoperative transfusion rates were no different for the group receiving TISSEEL compared with those of control ( P  = .375) and were statistically greater when compared with those of IV TXA ( P  = .002). Conclusion TISSEEL fibrin sealant does not reduce postoperative blood loss or transfusions; however, IV TXA reduced postoperative transfusions compared with TISSEEL and control. Therefore, TXA is recommended to reduce perioperative blood loss, while, utilization of a fibrin sealant requires further refinements before being adopted for routine use in THA.